Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep Apnea
Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep Apnea
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DOI：
10.1093/sleep/zsx183
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发表时间：
2018-01-01
期刊：
影响因子：
5.6
通讯作者：
Wellman, Andrew
中科院分区：
文献类型：
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作者：
Sands, Scott A.;Terrill, Philip I.;Wellman, Andrew
研究目标：阻塞性睡眠呼吸暂停 (OSA) 的精准医疗需要对每位患者的病理生理“特征”进行无创评估。在这里，我们提供了第一个量化呼吸唤醒阈值的自动化技术，定义为使用 OSA 患者的诊断性多导睡眠图信号触发睡眠唤醒的通气驱动水平。方法：通过将呼吸控制模型（Terrill 等）拟合到自发呼吸事件期间的通气模式，从多导睡眠图研究中估计临床评分唤醒之前的通气驱动。从概念上讲，唤醒发生后立即出现的气流信号的大小揭示了触发唤醒的潜在通气驱动的信息。将多导睡眠图唤醒阈值测量值与同时记录的食管压力和食管内隔膜肌电图的金标准值进行比较（N = 29）。还对使用持续气道正压通气 (CPAP) 调节的唤醒阈值测量进行了比较 (N = 28)。还评估了使用（线性化）鼻压而不是呼吸速度描记器通气的有效性（N = 11）。结果：多导睡眠图唤醒阈值与使用食管压和膈肌肌电图测量的阈值相关（R = 0.79，p < .0001；R = 0.73，p = .0001）以及 CPAP 操作（R = 0.73，p < .0001）。使用鼻压和呼吸速度描记器通气的唤醒阈值估计相似（R = 0.96，p < .0001）。结论：OSA 患者的唤醒阈值可以使用多导睡眠图信号进行估计，并且可以为低唤醒阈值的患者提供更个性化的治疗干预。
Study Objectives: Precision medicine for obstructive sleep apnea (OSA) requires noninvasive estimates of each patient's pathophysiological "traits." Here, we provide the first automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA.Methods: Ventilatory drive preceding clinically scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill et al.) to the pattern of ventilation during spontaneous respiratory events. Conceptually, the magnitude of the airflow signal immediately after arousal onset reveals information on the underlying ventilatory drive that triggered the arousal. Polysomnographic arousal threshold measures were compared with gold standard values taken from esophageal pressure and intraoesophageal diaphragm electromyography recorded simultaneously (N = 29). Comparisons were also made to arousal threshold measures using continuous positive airway pressure (CPAP) dial-downs (N = 28). The validity of using (linearized) nasal pressure rather than pneumotachograph ventilation was also assessed (N = 11).Results: Polysomnographic arousal threshold values were correlated with those measured using esophageal pressure and diaphragm EMG (R = 0.79, p < .0001; R = 0.73, p = .0001), as well as CPAP manipulation (R = 0.73, p < .0001). Arousal threshold estimates were similar using nasal pressure and pneumotachograph ventilation (R = 0.96, p < .0001).Conclusions: The arousal threshold in patients with OSA can be estimated using polysomnographic signals and may enable more personalized therapeutic interventions for patients with a low arousal threshold.